Changes of inflammation and nutritional status after operation in adenocarcinoma of the esophago-gastric junction and its effect on prognosis

doi:10.3877/cma.j.issn.1674-0793.2019.02.011

Abstract

Abstract:

Objective

To investigate the value of inflammatory markers (NLR and PLR) and nutritional indicators including prognostic nutritional factors (PNI), body mass index (BMI), hemoglobin, albumin, and prealbumin in patients with adenocarcinoma of the esophagogastric junction (AEG).

Methods

Between April 2010 and April 2013, a total of one hundred and fifty surgical AEG patients of type Ⅱ/Ⅲ. Data of NLR, PLR, BMI, hemoglobin, albumin, prealbumin and PNI were obtained within 1 week before operation. The sensitivity, specificity, accuracy, best cut-off value and area under the curve (AUC) of each index were analyzed by the receiver operating characteristic curve (ROC) to evaluate their diagnostic value. Kaplan-Meier curve and Log-rank test were used to calculate the survival rate. COX model was used to analyze the prognostic factors.

Results

The cut-off values of NLR, PLR and PNI were 3.5 (AUC 0.591, sensitivity 26.8, specificity 89.4), 171 (AUC 0.531, sensitivity 23.6, specificity 81.3) and 51.3 (AUC 0.599, sensitivity 63.1, specificity 57.2), respectively. The average survival time was 46.3 months in 5 years. Kaplan-Meier survival curve showed that the prognostic survival time of AEG patients with prealbumin<180 mg/L, NLR>3.5 and low BMI (<18.5 kg/m²) was shorter (all P=0.010). Multivariate regression analysis showed that TNM stage (P<0.001, 95%CI=1.739-3.525), BMI (P=0.011, 95%CI=0.564-0.928), NLR (P<0.001, 95%CI=1.617-3.280) and prealbumin (P<0.001, 95%CI=0.310-0.592) were independent risk factors for the prognosis of AEG patients. NLR was correlated with tumor type and tumor size (χ²=7.156, 7.567; P=0.028, 0.023); BMI was correlated with age and operation time (χ²=7.339, 6.414; P=0.025, 0.011); prealbumin was correlated with gender, tumor size, differentiation and TNM stage (χ²=4.746, 13.574, 3.888, 4.024; P=0.029, <0.001, 0.049, 0.045).

Conclusions

Inflammatory response and nutritional status promote disease progression in AEG patients with type /. BMI, NLR and prealbumin levels are independent risk factors for the prognosis of AEG patients.

Key words: Adenocarcinoma, Esophagogastric junction, Inflammation, Nutrition assessment, Prognosis

Nengqi Cao, Xiaogang Cao, Baolin Sun, Yonghui Quan, Chunsheng Wei. Changes of inflammation and nutritional status after operation in adenocarcinoma of the esophago-gastric junction and its effect on prognosis[J]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(02): 137-142.

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References 18

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项目		例数	百分比(%)	χ²值	P值
性别		?	?	0.251	0.992
?	男	118	47.4	?	?
?	女	32	43.8	?	?
年龄(岁)		?	?	4.460	0.035
?	<60	37	49.4	?	?
?	≥60	113	46.2	?	?
肿瘤大小(cm)		?	?	23.821	<0.001
?	<5	72	61.6	?	?
?	≥5	78	34.4	?	?
分化程度		?	?	5.636	0.018
?	差	102	42.9	?	?
?	好	48	54.3	?	?
TNM分期		?	?	34.559	<0.001
?	Ⅰ~Ⅱ	65	66.9	?	?
?	Ⅲ~Ⅳ	85	31.8	?	?
肿瘤Siewert分型		?	?	0.444	0.505
?	Ⅱ	105	48.5	?	?
?	Ⅲ	45	44.4	?	?
BMI (kg/m²)		?	?	17.253	<0.001
?	<18.5	9	25.6	?	?
?	18.5~<25	100	44.8	?	?
?	≥25	41	63.1	?	?
血红蛋白(g/L)		?	?	10.614	0.001
?	<120	60	36.2	?	?
?	≥120	90	55.9	?	?
白蛋白(g/L)		?	?	3.512	0.061
?	<40	39	40.2	?	?
?	≥40	111	50.2	?	?
前白蛋白(g/L)		?	?	48.110	<0.001
?	<180	35	22.9	?	?
?	≥180	115	57.2	?	?
PNI		?	?	6.537	0.010
?	<51.3	82	41.2	?	?
?	≥51.3	68	56.7	?	?
NLR		?	?	28.786	<0.001
?	<3.5	124	52.2	?	?
?	≥3.5	26	24.2	?	?
PLR		?	?	7.421	0.006
?	<171	119	51.1	?	?
?	≥171	31	33.3	?	?

项目		例数	百分比(%)	χ²值	P值
性别		?	?	0.251	0.992
?	男	118	47.4	?	?
?	女	32	43.8	?	?
年龄(岁)		?	?	4.460	0.035
?	<60	37	49.4	?	?
?	≥60	113	46.2	?	?
肿瘤大小(cm)		?	?	23.821	<0.001
?	<5	72	61.6	?	?
?	≥5	78	34.4	?	?
分化程度		?	?	5.636	0.018
?	差	102	42.9	?	?
?	好	48	54.3	?	?
TNM分期		?	?	34.559	<0.001
?	Ⅰ~Ⅱ	65	66.9	?	?
?	Ⅲ~Ⅳ	85	31.8	?	?
肿瘤Siewert分型		?	?	0.444	0.505
?	Ⅱ	105	48.5	?	?
?	Ⅲ	45	44.4	?	?
BMI (kg/m²)		?	?	17.253	<0.001
?	<18.5	9	25.6	?	?
?	18.5~<25	100	44.8	?	?
?	≥25	41	63.1	?	?
血红蛋白(g/L)		?	?	10.614	0.001
?	<120	60	36.2	?	?
?	≥120	90	55.9	?	?
白蛋白(g/L)		?	?	3.512	0.061
?	<40	39	40.2	?	?
?	≥40	111	50.2	?	?
前白蛋白(g/L)		?	?	48.110	<0.001
?	<180	35	22.9	?	?
?	≥180	115	57.2	?	?
PNI		?	?	6.537	0.010
?	<51.3	82	41.2	?	?
?	≥51.3	68	56.7	?	?
NLR		?	?	28.786	<0.001
?	<3.5	124	52.2	?	?
?	≥3.5	26	24.2	?	?
PLR		?	?	7.421	0.006
?	<171	119	51.1	?	?
?	≥171	31	33.3	?	?

因素	β	SE	Wald	HR	HR的95%置信区间	P值
中性粒细胞-淋巴细胞比(NLR)	0.821	0.180	20.764	2.303	1.617~3.280	<0.001
血小板-淋巴细胞比(PLR)	0.125	0.180	0.483	1.124	0.789~1.602	0.517
分化程度	0.180	0.166	1.171	1.242	0.895~1.724	0.194
肿瘤大小	0.174	0.175	0.982	1.178	0.835~1.661	0.352
TNM分期	0.869	0.181	23.128	25.292	1.739~3.525	<0.001
年龄	0.079	0.177	0.197	1.018	0.999~1.038	0.063
体质量指数(BMI)	-0.333	0.128	6.771	0.724	0.564~0.928	0.011
前白蛋白	-0.846	0.164	26.535	0.428	0.310~0.592	<0.001
血红蛋白	-0.087	0.170	0.264	0.943	0.674~1.318	0.730
预后营养因子(PNI)	0.157	0.185	0.723	1.192	0.828~1.715	0.345

因素	β	SE	Wald	HR	HR的95%置信区间	P值
中性粒细胞-淋巴细胞比(NLR)	0.821	0.180	20.764	2.303	1.617~3.280	<0.001
血小板-淋巴细胞比(PLR)	0.125	0.180	0.483	1.124	0.789~1.602	0.517
分化程度	0.180	0.166	1.171	1.242	0.895~1.724	0.194
肿瘤大小	0.174	0.175	0.982	1.178	0.835~1.661	0.352
TNM分期	0.869	0.181	23.128	25.292	1.739~3.525	<0.001
年龄	0.079	0.177	0.197	1.018	0.999~1.038	0.063
体质量指数(BMI)	-0.333	0.128	6.771	0.724	0.564~0.928	0.011
前白蛋白	-0.846	0.164	26.535	0.428	0.310~0.592	<0.001
血红蛋白	-0.087	0.170	0.264	0.943	0.674~1.318	0.730
预后营养因子(PNI)	0.157	0.185	0.723	1.192	0.828~1.715	0.345

项目		NLR		BMI		前白蛋白
项目		χ²值	P值	χ²值	P值	χ²值	P值
性别		0.042	0.837	2.249	0.325	4.746	0.029
?	男	?	?	?	?	?	?
?	女	?	?	?	?	?	?
年龄(岁)		2.048	0.152	7.156	0.028	2.879	0.090
?	< 60	?	?	?	?	?	?
?	≥ 60	?	?	?	?	?	?
肿瘤Siewert分型		7.339	0.025	0.805	0.938	1.696	0.428
?	Ⅱ	?	?	?	?	?	?
?	Ⅲ	?	?	?	?	?	?
TNM分期		0.010	0.919	0.363	0.834	4.024	0.045
?	Ⅰ~Ⅱ	?	?	?	?	?	?
?	Ⅲ~Ⅳ	?	?	?	?	?	?
分化程度		1.276	0.259	0.850	0.654	3.888	0.049
?	差	?	?	?	?	?	?
?	好	?	?	?	?	?	?
肿瘤大小（cm）		6.414	0.011	1.137	0.566	13.574	<0.001
?	<5	?	?	?	?	?	?
?	≥ 5	?	?	?	?	?	?
手术时间(min)		0.239	0.625	7.567	0.023	0.335	0.563
?	<177	?	?	?	?	?	?
?	≥ 177	?	?	?	?	?	?

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